Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Acute phlegmonous esophagitis
- Radiologic Findings
- Figs 1. Chest CT scan shows diffuse edematous circumferential wall thickening of the esophagus with intramural low density area. Intramural low attenuation is surrounded by peripheral enhancing rim.
Figs 2. After 2 weeks, CT reveals mucosal defect and flap at the esophagus, which suggests intramural dissection.
Fig 3. Gastrograffin esophagography after 2 weeks reveals double lumen feature of the entire esophagus and blind end of the posterior wall side lumen, possible false lumen.
- Brief Review
- Acute phlegmonous esophagitis is uncommon disorder. A bacterial infection occurs in the submucosa and musculature of the esophagus. Phlegmonous infection usually involves the submucosa and not the mucosa. Phlegmonous infection may involve any gastrointestinal tract site, although the stomach is most frequently involved.
The pathogenesis of acute phlegmonous esophagitis is unclear. Reported predisposing factors include immune suppression, alcoholism, peptic ulcer disease, chronic gastritis or some other gastric mucosal injury, achlorhydria, infection, connective tissue disease, and malignancy.
The reported CT findings of phegmonous esophagitis are esophageal wall thickening and intramural low-density areas. The area of intramural low attenuation surrounded by a peripherally enhancing rim represents intramural abscess. The air bubbles in the thickened esophageal wall seen on CT may be produced by gas-forming organisms (indicating emphysematous esophagogastritis), or the air bubbles may have entered the wall when the intramural abscess spontaneously drained into the lumen.
- Please refer to
Case 822, Case 1074, -
- References
- 1.Jung C et al. Acute Diffuse Phlegmonous Esophagogastritis: Radiologic Diagnosis. American Journal of Roentgenology. 2003;180:862-863
2. Kim HS et al. Acute Diffuse Phlegmonous Esophagogastritis: A Case Report. J Korean Med Sci. 2010; 25(10): 1532
- Keywords
- esophagus, esophagitis, phlegmonous esophagitis,